Provider Demographics
NPI:1932725595
Name:ALEN, YUDITH DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:YUDITH
Middle Name:DE LA CARIDAD
Last Name:ALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12260 SW 8TH ST STE 156
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1508
Mailing Address - Country:US
Mailing Address - Phone:786-332-4326
Mailing Address - Fax:
Practice Address - Street 1:2403 W 76TH ST APT 206
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5663
Practice Address - Country:US
Practice Address - Phone:786-399-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20120214106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician